DSIP projects are mainly delivered through private contractors, district administrations or by the facilities themselves (Table 7-3). Private contractors implement most health projects (57 per cent), but schools are much more likely to implement their own projects (45 per cent). This probably reflects the fact that schools have more autonomy and capacity to manage their own projects. It may also be that school projects are simpler, as well as less expensive.
Table 7-3: DSIP implementation modalities (%)
Schools Health clinics
DSIP project implementation by:
Facility 45 14
Private contractor 14 57
District administration 25 22
Another process 16 7
Note: Percentage of those facilities that report a DSIP project.
For health clinics, only one-third of DSIP projects were completed in full and on time (Table 7-4). Schools did much better, with almost two- thirds of projects completed in full and on time. For both types of facility, projects that were behind schedule were seriously delayed (by about a year on average). In fact, respondents thought that about 40- 45 per cent of projects that were delayed would never be finished. This means that 31 per cent of all DSIP health projects are forecast never to be finished, and 16 per cent of all DSIP school projects.
Table 7-4: DSIP completion rates and implementation delays
Schools Health clinics
DSIP project completed in full and on time (%) 65 32 If not completed in full and on time…
months project is behind schedule 12 11 project will never be completed (%) 41 45
It should also be borne in mind that completion does not mean utilisation. We did not formally ask this in the survey, but the experience of coming across a brand-new but yet-to-open health centre in Gulf Province was striking. We were told that basic construction had been completed more than 12 months ago, but that the clinic could not be opened due to a dispute between government and church health officials about ownership of the health facility and who would be responsible for finding a health worker to take up the vacant post at the centre.
A new, but unopened health clinic built in Gulf Province with funding from the District Service Improvement Program.
DSIP: ARE HEALTH AND EDUCATION BENEFITTING | 133
7.4 Conclusion
There are many arguments about the DSIP and whether it is a good use of public funds, but it seems certain to stay. Not only is the government committed to maintaining a very high level of public expenditure going to DSIP and similar funds. Recent legislative moves indicate a desire to effect bureaucratic change to expand capacity at the district level and consolidate the local decision-making power of MPs.
The District Development Authorities Bill was introduced into the PNG Parliament in late 2013. The District Development Authority will replace the JDPBPC, which is currently the decision maker concerning the DSIP. All public servants in the district, including police, teachers and health workers are proposed to come under the District Development Authority, the CEO of which will be the District Administrator. The Members of Parliament that represent open district electorates and hold 89 of the 111 seats in the National Parliament (commonly referred to as Open MPs) will be the Chair of their respective District Development Authority, giving them greater influence over funding allocations and human resources.
Given all this, it is important to learn what we can from the functioning of the DSIP to date. What can we conclude from this study?
First, not a lot of funding seems to be flowing from the DSIP to PNG’s schools and health facilities. If we take the average amount going to schools and health centres, and multiply this by the total number of each, the complete value of cumulative DSIP funding as of 2012 to primary schools is K46.2 million and to health facilities is K37.6 million, with a total of K83.8 million. This is 23 per cent of a single year’s allocation of the DSIP prior to the 2013 increases. But we asked facilities if they had ever received a DSIP-funded project. The projects reported could have been funded out of several years’ allocations. If they were funded out of four allocations, then the percentage flowing to primary health and education falls to just 6 per cent. This is just a rough estimate, but it does suggest that little from the DSIP is making its way to PNG’s schools and health clinics.
Clearly, the increased funding should make a difference. If the same share of DSIP funding continues to go to health and education then, after a few years, we can expect the inflow to primary health facilities and schools to increase fourfold to K352 million. But if health and education get their regulated share, then the stock of projects underway at any one time should be at least double that (allowing some funding to flow to secondary schools and hospitals).
We cannot say whether health and education are getting so little because other sectors are getting a lot more or because of waste and corruption. But it is clearly in the interests of individual schools and health facilities, as well as their national departments, to lobby for more funding.
Second, there is general dissatisfaction with the fairness of how the DSIP projects are allocated. Reforms should be considered to allow schools and health facilities to bid directly for projects, and rules should be developed to allow all facilities to access funding periodically. Third, projects are often either significantly behind schedule or never completed. About 30 per cent of all the DSIP health projects and 16 per cent of all the education projects are forecast never to be finished. Two-thirds of the health projects and one-third of the education projects are a year behind schedule. Poor spending and delays with implementation can be damaging for the reputation of the DSIP at the local level, and of course are bad for value for money.
Fourth, we once again see a difference between the health sector and the education sector. Education projects are almost twice as likely to be finished on time. Schools are much more likely to receive funding in cash, and to be in charge of the projects themselves. Perhaps this makes it easier to run a successful DSIP project? More generally, it is likely that the better developed governance structures at schools mean that their projects are more likely to succeed.
Fourth, projects may be completed but not used. There is clear evidence from our survey of the need for new and rehabilitated infrastructure in most provinces, from run-down health clinics to dilapidated teachers’ housing. The DSIP has been, and continues to be, the main funding source that can finance these types of projects. The relative capacity of provinces to ensure contractors are monitored and projects are completed on time is widely variable, but important to ensuring effective spending. The focus should be on maintenance and replacement, not the construction of new, additional assets. MPs and administrators should coordinate closely to ensure that new facilities are not left idle, or, put differently, that construction is only undertaken where staff are available to make use of the facilities being built.
PART FOUR:
EXPLAINING
FACILITY LEVEL EXPLANATIONS OF
PERFORMANCE
8.1 Introduction
The statistics presented in Chapters 3 to 7 have aimed to summarise important characteristics at the facility level. The averages presented in the tables and charts have enabled comparisons of average facility performance across points in time, facility types, province, and agency. They have shown many interesting differences. We have attempted throughout the report to explain these differences. For example, it seems likely that schools have fared better than health clinics over the last decade because they have been better financed, better governed, and better staffed.
But to get a better understanding we need to go beyond averages. The objective of this section is to relate facility characteristics to performance outcomes and test these relationships through regression analysis. This approach can not only identify facility level explanations of performance but can also quantify the marginal impact of variations of facility inputs on performance outcomes.
The findings for schools indicate that while location and funding is important, good performance is strongly associated with indicators of the quality of management and level of management effort at the school level. These characteristics are in turn dependent on the extent of formal oversight by Standards Officers and informal oversight by the school community. The main finding for health clinics is that revenue from user fees and support from health funding providers are key inputs to achieving good performance outcomes across a range of measures. The result highlights the importance of good financial management at health clinics, in particular collecting and managing user fees, an ability to source financing and support from funding providers, and a desire to use these resources to undertake key activities at the clinic.